Changes in bone mineral density in children with autoimmune hepatitis on the background of immunosuppressive therapy

Introduction. The chronic course of autoimmune hepatitis requires long-term immunosuppressive therapy, which can lead to side effects such as impairement of bone mineral density (BMD). Currently, there are no data assessing bone mineralization in children with autoimmune hepatitis. Aim. To determine the bone mineral density by densitometry and bone remodelling biochemical markers in children with autoimmune hepatitis. Materials and methods. The study included 41 child with autoimmune hepatitis. 18 patients were diagnosed for the first time and received no treatment before admission, 15 children took glucocorticosteroids up to 6 months and 8 patients received them for 6 months or more. The study required clinical: age and sex of patients, duration both of the disease and treatment, body mass index, laboratory (ALT, AST, total immunoglobulin G, osteocalcin, procollagen type 1 N-terminal propeptide (P1NP), βCrossLaps, calcium, phosphorus, parathormone, vitamin D), instrumental examination (lumbar radiodensitometry, liver elastography). Results. Children with autoimmune hepatitis at the age of 16 years and older had lower densitometry Z-score (p = 0.015). There was no statistically significant difference between bone mineral density Z-score and the treatment duration. BMD Z-score was established to correlate with P1NP in blood serum (p = 0.035) and osteocalcin (p = 0.026). Conclusion. Autoimmune hepatitis is a chronic liver disease, associated with the risk for bone density mineral disorders, including in children. This requires timely assessment of one remodelling state, as well as calcium and vitamin D prescription for concomitant treatment.